Department of Orthopeadics and Traumatology, İnönü University, Malatya-Türkiye.
Department of Orthopaedics and Traumatology, Hasan Çalık State Hospital, Malatya-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2024 Jul;30(7):500-509. doi: 10.14744/tjtes.2024.06228.
Crush syndrome (CS) is characterized by high morbidity and mortality due to severe electrolyte disorders, circulatory dysfunction, and multiple organ failure, secondary to severe rhabdomyolysis and reperfusion injuries. Acute kidney injury (AKI) related to crush syndrome is one of the life-threatening complications and is the most frequent cause of death following earthquakes, other than trauma. We conducted a retrospective study to identify predictive parameters from clinical and laboratory data that aid in recognizing CS, assessing its severity, and evaluating acute kidney injury and amputation indications in patients.
We retrospectively evaluated the clinical data and laboratory follow-up of 33 patients treated for crush syndrome within the first two weeks following the February 6, 2023 earthquake. Patients who underwent surgery for crush syndrome but could not be followed post-surgery were excluded. Laboratory parameters were analyzed upon admission and then daily over an average seven-day follow-up. A p-value of <0.05 was considered statistically significant. Data analysis was performed using IBM SPSS Statistics 26.0 and R Studio software.
Of the 33 patients, 17 were male and 16 were female. The incidence of AKI was 35.7%, 66.7%, and 100% in patients with injuries to one, two, and three extremities, respectively. A significant correlation was observed between total entrapment time and the duration of required dialysis days; AKI risk significantly increased with more than six hours of total entrapment time. Regarding the initial blood values upon hospital admission, a myoglobin level exceeding 2330 mg/dL demonstrated the highest sensitivity for predicting AKI. An initial uric acid level (>6.36 mg/dL) on admission had the highest specificity for predicting AKI. The initial myoglobin level (>3450 mg/dL) showed the highest sensitivity in predicting the need for amputation. Meanwhile, the mean creatine kinase (CK) level (>34800 U/L) exhibited the highest specificity but the lowest sensitivity for amputation prediction.
The study analyzed the effectiveness and predictability of clinical and laboratory findings concerning amputation and acute kidney injury in crush syndrome resulting from earthquakes. Effective amputation management is a crucial factor influencing prognosis and survival in patients with earthquake-induced crush syndrome.
挤压综合征（CS）的特点是严重的电解质紊乱、循环功能障碍和多器官衰竭，这是由于严重的横纹肌溶解和再灌注损伤引起的，发病率和死亡率都很高。与挤压综合征相关的急性肾损伤（AKI）是一种危及生命的并发症，是除创伤外导致地震后死亡的最常见原因。我们进行了一项回顾性研究，以确定有助于识别 CS、评估其严重程度以及评估患者急性肾损伤和截肢指征的临床和实验室数据中的预测参数。
我们回顾性评估了 2023 年 2 月 6 日地震后两周内接受挤压综合征治疗的 33 例患者的临床数据和实验室随访情况。排除了因挤压综合征接受手术但术后无法随访的患者。入院时和平均 7 天随访期间每天分析实验室参数。p 值<0.05 被认为具有统计学意义。使用 IBM SPSS Statistics 26.0 和 R Studio 软件进行数据分析。
33 例患者中，17 例为男性，16 例为女性。受伤 1、2 和 3 个肢体的患者 AKI 的发生率分别为 35.7%、66.7%和 100%。总束缚时间与需要透析天数之间存在显著相关性；总束缚时间超过 6 小时，AKI 风险显著增加。关于入院时的初始血液值，肌红蛋白水平超过 2330mg/dL 对预测 AKI 的敏感性最高。入院时尿酸水平（>6.36mg/dL）对预测 AKI 的特异性最高。初始肌红蛋白水平（>3450mg/dL）对预测截肢的敏感性最高。同时，平均肌酸激酶（CK）水平（>34800U/L）对截肢预测的特异性最高，但敏感性最低。
本研究分析了地震引起的挤压综合征中截肢和急性肾损伤的临床和实验室发现的有效性和可预测性。有效的截肢管理是影响地震引起的挤压综合征患者预后和生存的关键因素。
